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UW Family Medicine Residency Program: Enhancing Healthcare in Wyoming

The UW Family Medicine Residency Program (FMRP) in Casper and Cheyenne aims to train resident physicians in family medicine, provide training for students in other health fields, and offer a safety net healthcare system to Wyoming citizens. With clinics across the state, the FMRP plays a vital role in providing comprehensive healthcare to patients across all age groups, from obstetrics to geriatrics. The program also offers additional opportunities such as a Rural Training Track and a Geriatrics Fellowship. By obtaining the Federally Qualified Health Center Look-Alike (FQHC-LA) designation, the FMRP is able to access grant funding, pharmacy pricing benefits, and enhanced reimbursements. The Educational Health Center of Wyoming (EHCW) oversees the FMRP clinics, which are funded by a combination of general funds, clinic revenue, and HRSA grants.

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UW Family Medicine Residency Program: Enhancing Healthcare in Wyoming

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  1. The UW Family Medicine Residency Programand The Educational Health Center of Wyoming

  2. UW Family Medicine Residency Program (FMRP) Casper – Cheyenne Purposes Train Resident Physicians in Family Medicine Provide training for students in other health fields Provide safety net health care to citizens of Wyoming

  3. UW FMRP Clinics: Benefit to the State 42 Family Medicine Resident Physicians providing health care across the lifespan--obstetrics to geriatrics (24 in Casper, 18 in Cheyenne) ~103 Family Medicine Physicians practicing in Wyoming are graduates of the FMRP Opportunities Family Medicine Resident Rural Training Track Geriatrics Fellowship (with VA Hospital in Sheridan)

  4. UW FMRP Clinics: Benefit to the State July 2017 thru May 2018 FMRP-Casper 27,114 patient visits FMRP-Cheyenne 17,954 patient visits

  5. UW FMRP Clinics 2012 FMRP was increasingly reliant on general funds State continued to face fiscal challenges Governor Mead directed UW to study options that might reduce this increased reliance on general fund

  6. UW FMRP Clinics 2012 UW created a stakeholder group to study possibilities for generating revenue beyond the General Fund The stakeholder group recommended: Seek Health Resources & Services Administration (HRSA) designation of Federally Qualified Health Center Look ALike (FQHC-LA) Governor supported this recommendation

  7. UW FMRP Clinics Benefits of FQHC Increased opportunities for HRSA grant funding 340b Pharmacy pricing Enhanced reimbursements from Medicaid and Medicare National Health Services Corps loan repayment program for providers

  8. UW FMRP Clinics 2014 HRSA designated the FMRP as a FQHC-Look Alike Governing body for the FQHC-LA The Educational Health Center of Wyoming (EHCW) The UW and the EHCW became HRSA co-applicants

  9. UW FMRP Clinics and EHCW 2016 UW-EHCW applied to HRSA for funding that would establish a third clinic in Laramie Funding was awarded to the Laramie Clinic as a “New Access Point” Resulted in the designation of a “full” FQHC

  10. Educational Health Center of Wyoming (EHCW) UW Family Medicine Residency Clinics Casper Cheyenne Albany Community Health Center Laramie

  11. The EHCW • Casper and Cheyenne Clinics • Integral part of the UW FMRP • Funded by General Fund and Clinic Revenue • Albany Community Health Center (ACHC) • Newest addition – Funded by HRSA and Clinic revenue • No UW or General Funds support the ACHC

  12. The EHCW, UW, and the State of Wyoming • Casper and Cheyenne Residency Clinics • Funding structure: Viewed as a “State Agency” • Clinic revenue considered to be State revenue • This structure has created challenges for the Clinics

  13. The EHCW, UW, and the State of Wyoming Challenges • Current governance structure is complex and may not fully comply with the expectations of HRSA for a FQHC • The current budget process for the UW FMRP limits the FMRP’s ability to run modern-day clinics • Current budget process does not allow the enhanced revenue received via FQHC designation to flow back to clinic operations (which is expected by HRSA) • The EHCW has little authority over the FQHC

  14. Educational Health Center of Wyoming University of Wyoming July 2017

  15. Addressing the HRSA issue • Fall 2017 • UW hired consultant to assess current organizational structure and provide recommendations to ensure HRSA compliance • Consultant identified areas of concern -- developed possible work plan to address HRSA-related issues

  16. General Fund / Clinic Revenue Levels

  17. Addressing the HRSA issue • December 2017 • Began discussing issues with Joint Appropriations Committee…asked for guidance • March 2018 • HRSA site visit: Concerns raised regarding current administrative and fiscal structure

  18. The EHCW, UW, and the State of Wyoming Select Committee formed with the following charge: “The select committee shall study and make recommendations on the operations, organizational structure, services and funding of the University of Wyoming family medicine residency programs. The select committee shall submit a report summarizing its studies and recommendations to the joint appropriations committee on or before November 12, 2018. The joint appropriations committee shall consider the recommendations and develop any legislation it deems appropriate for consideration by the legislature.”

  19. Desired Outcome of Select Committee Meetings Guidance as to how the FMRP Clinics can operate as a Federally Qualified Health Center and still meet state expectations Clinic revenues must flow back to clinical operations to enhance and expand services Recommendations that would separate FMRP functions to allow a clear separation of authority

  20. University of Wyoming Educational Health Center of Wyoming • UW -- Education • Resident Education • Clinical Research & Scholarly Activity • State Budget Requests • EHCW Board • Clinic Mission, Vision, and Values • Monitor Quality of Care • Monitor staffing levels and make recommendations • HRSA • Monitor Clinic Revenue & Use

  21. Possible Model for EHCW: ‘Block Grant’ Clinic Revenues UW continues to have oversight of personnel Clinics can use patient revenues to operate and enhance services

  22. Possible Model for EHCW: 501c3 Status Bluegrass Community Health Center (BCHC) Co-applicant with Eastern Kentucky University BCHC is a 501c3 BCHC is completely self-funded Clinic revenue – Salaries for Professional Staff Grants/Contracts – Salaries for Support Staff

  23. Possible Model for EHCW: Bluegrass Community Health Center BCHC provides student education (EKU) APRN and Psychiatric APRN students BSN Students Athletic Training Medical Management Public Health Family Medicine Residents from U Kentucky

  24. Possible Model for EHCW: Bluegrass Community Health Center All employees of BCHC are EKU employees BCHC pays EPBs into EKU BCHC pays its malpractice insurance into EKU

  25. Possible Model for EHCW: Bluegrass Community Health Center Indirect Costs go to EKU -- Services provided: Human Resources General Counsel Sponsored Programs Procurement Contracts Proposal Requests OSHA Training

  26. UW provides support for: HR, General Counsel, Procurement, Sponsored Programs • UW -- Education • Resident Education • Clinical Research & Scholarly Activity • State Budget Requests • EHCW Board • Clinic Mission, Vision, and Values • Monitor Quality of Care • Monitor staffing levels and make recommendations • HRSA • Monitor Clinic Revenue & Use EHCW pays the UW: EPBs and cost of Malpractice insurance

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